Epiglottitis

What is epiglottitis?

Epiglottitis is an acute life-threatening bacterial or viral infection that results in swelling and inflammation of the epiglottis. The epiglottis is an elastic cartilage structure at the root of the tongue that prevents food from entering the windpipe (trachea) when swallowing. Epiglottitis makes it difficult to breathe and progresses quickly. If not treated, it can be life-threatening because there is so much swelling that air cannot get in or out of the lungs.

What causes epiglottitis?

The main cause of epiglottitis is a bacterial infection that can be spread through the upper respiratory tract. The bacteria usually is Haemophilus influenzae type B (HIB). Another bacteria that can cause epiglottitis is group A ß-hemolytic streptococci. The reason some children develop the disease, while others do not, is not completely understood. A vaccine to to help prevent epiglottitis is recommended for all children beginning at age 2 months.

What are the symptoms of epiglottitis?

The following are the most common symptoms of epiglottitis. However, each child may experience symptoms differently. In some children, symptoms of epiglottitis begin with symptoms of an upper respiratory infection.

Symptoms may include:

Quick onset of a very sore throat

Fever

Drooling

Difficulty swallowing

Muffled voice

No cough

Cyanosis (blue skin coloring)

Stridor (a high-pitched sound that is usually noted as the child breathes in)

As the disease worsens, the following symptoms may appear:

Difficulty breathing

Unable to talk

The child sits leaning forward

The child keeps his or her mouth open

The child is distressed or anxious

How is epiglottitis diagnosed?

Epiglottitis is an emergency. The main concern with suspected epiglottitis is to make sure the child is able to breathe. The child will likely be hospitalized so that breathing can be managed. Once breathing is established, the doctor will visualize the airway. Usually this is enough to confirm epiglottitis. In some cases, a laryngoscopy or X-ray may be done.

Do not try to try to examine your child's throat at home. This can cause further swelling which may block the airway entirely.

How is epiglottitis treated?

The treatment for epiglottitis requires immediate emergency care to prevent complete blockage of the airway. Epiglottitis progresses rapidly. A breathing tube will be put in place right away and the child's airway will be closely monitored. If needed, the child's breathing will be assisted with machines.

Intravenous (IV) therapy with antibiotics will be started immediately. This will help treat the infection by the bacteria. Treatment may also include:

Steroid medication (to reduce airway swelling)

Intravenous (IV) fluids, until the child can swallow again

How well the child recovers from this disease is related to how quickly treatment begins in the hospital setting. Once the child is being monitored, the airway is safe, and antibiotics are started, the disease usually stops progressing within 24 hours. Complete recovery takes longer and depends on each child's condition.

Can epiglottitis be prevented?

As mentioned above, epiglottitis caused by the bacteria HIB can be prevented with vaccines that start at the age of 2 months. Epiglottitis caused by other organisms cannot be prevented at this time, but are much less common.

To help prevent epiglottitis, the CDC recommends infants receive 3 to 4 doses of the HIB vaccine. Primary doses are given at 2 and 4 months of age or at 2, 4, and 6 months of age, based on the brand used by the doctor's office. A booster dose is given by 12 to 15 months of age.

The HIB vaccine protects against this bacteria, therefore decreasing the chance of developing epiglottitis.

If a child is diagnosed with epiglottitis, the child's family or other close contacts are usually treated with a medication called rifampin, to prevent the disease in those people who might have been exposed.

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